"The Authorities Should Focus Their Efforts on Super-Spreaders"
German parliamentarian and health expert Karl Lauterbach says Germany's coronavirus strategy must change. Instead of contact tracing, he demands that more attention be focused on super-spreaders.
Interview Conducted by Markus Feldenkirchen
Foto: Andreas Gora/ ddp images
DER SPIEGEL: Mr. Lauterbach, what is your greatest concern these days?
Lauterbach: The second wave.
DER SPIEGEL: Will we have one?
Lauterbach: It's already developing. We rode out the first one reasonably well. We would have done even better if we had continued the lockdown for another two to three weeks. Now, we are at the beginning of the second wave. To manage this one, we urgently need a change of strategy when it comes to battling the pandemic.
DER SPIEGEL: What could we do to prevent a sharp increase in the number of infections this fall?
Lauterbach: We can't afford another strict lockdown. That would be terrible. But we also have to assume that people won't be as disciplined - practicing social distancing or wearing masks – as they were during the first wave. As such, the health authorities and their strategies will be decisive.
DER SPIEGEL: Thus far, the authorities have been tracking all the contacts from new infections in order to break the chain. What's wrong with that strategy?
Lauterbach: This approach is totally inefficient; we're on the wrong track. Instead of contacting each individual contact by phone, the authorities should focus their efforts on so-called super-spreaders, those few highly contagious cases that often infect dozens of people in group situations. They alone are the driving force behind the pandemic. We now know that individual transmitters have almost no effect on the exponential growth. If we don't change course on this issue, the second wave will be intense.
DER SPIEGEL: Why is the strategy being followed thus far so inefficient?
Lauterbach: It is a huge amount of work that uses a massive number of personnel that has almost no effect. We are unsuccessfully trying to catch up with the pandemic. Patients are isolated at a time when they are hardly contagious any longer. By then, they have long since passed the virus on to others.
Those who fall ill typically go to the doctor on the second day of exhibiting symptoms. That is frequently the fourth day of the infection, since the first two days tend to be free of symptoms. By the time the test results come back from the laboratory, two more days pass, sometimes more.
On average, then, patients are isolated six to seven days after becoming infected. The quarantine comes too late to break the infection chain. The individual contacts that are then examined are no longer contagious by then. We have to become faster.
DER SPIEGEL: How?
Lauterbach: I am in favor of adopting Japan's strategy, which has proven most effective in the fight against super-spreaders. The Japanese didn't impose a strict lockdown during the first wave, but they were roughly as successful as we were. That is exactly what we need for the second wave. The virologist Christian Drosten (one of Germany’s leading figures in the COVID-19 crisis) also sees this strategy as the correct course of action.
DER SPIEGEL: What would that mean for Germany's health authorities?
Lauterbach: When someone is tested, they must be systematically questioned with the help of a form whether they were present at a potential super-spreader in the preceding days -- a choir event, a wedding -- or if they are a teacher in a school.
If the test is positive, all other participants in the event must be immediately quarantined without delay, even before they are tested. That is the only way to prevent them from passing the virus along during the period in which they are contagious.
DER SPIEGEL: What if someone in a class at school becomes infected?
Lauterbach: Then all students in the class and their families must be quarantined for a week. That is the only way to prevent classrooms from becoming super-spreader sites. More than a week of quarantine, by the way, isn't necessary. Positive cases are hardly ever contagious for longer than that, even if they are still sick.
DER SPIEGEL: What would then happen with positive cases who haven’t attended group events?
Lauterbach: Health officials would no longer have to pursue their contacts because they are irrelevant for the development of the pandemic. Agencies and laboratories would then have sufficient capacities to concentrate on the super-spreaders. What we have done so far is a pure waste of resources. The strategy pursued thus far by health officials has also long since been scientifically invalidated. We are no longer keeping up with the research.
DER SPIEGEL: Would it be better to reimpose the ban on large groups?
Lauterbach: We need to do all we can to prevent large gatherings by imposing bans and severe penalties. Bundesliga football matches with spectators should not be allowed. People who go to parties and do not observe social distancing rules, such as at the large party recently in Berlin's Hasenheide park, must be penalized with fines in the hundreds of euros – fines that must actually be imposed.
DER SPIEGEL: What role do you believe the Robert Koch Institute (RKI) should play?
Lauterbach: It must become much more involved in the strategy for battling the second wave. The RKI has delegated too much to local health officials, who are overwhelmed by the work, though they are working extremely hard. We now need more than daily appeals from the RKI to maintain social distance and wear masks, as correct as such appeals may be. We need clear and helpful plans.
Karl Lauterbach, born in 1963, is a health expert with Germany's Social Democratic Party and has been a member of German parliament since 2005. Lauterbach is a medical doctor, having studied medicine in Aachen, Texas and Düsseldorf. He also studied epidemiology and health economics at Harvard University. From 1998 to 2005, he was director of Cologne University's Institute of Health Economics and Clinical Epidemiology.
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